Inflammatory bowel disease in children associated with juvenile psoriatic arthritis: features of joint syndrome

Background. Inflammatory bowel diseases, which include Crohn's disease and ulcerative colitis, are immune-mediated inflammatory diseases with a complex pathogenesis. In addition to the involvement of the intestinal wall in the pathological process, systemic extraintestinal manifestations are observed in Crohn's disease and ulcerative colitis, and there is also often an association with psoriasis and psoriatic arthritis.

Objective. Purpose of the study was to analyze the nature of the articular syndrome in children with inflammatory bowel diseases associated with juvenile psoriatic arthritis.

Materials and methods. A retrospective analysis of the nature of the articular syndrome was carried out in a group of children with inflammatory bowel diseases associated with juvenile psoriatic arthritis (20 patients, mean age 12.7 years (95% CI [11.01; 14.29]). The diagnosis of juvenile psoriatic arthritis was established according to the Vancouver diagnostic criteria (1989). The diagnosis of Crohn's disease was established in accordance with Clinical recommendations for Crohn's disease for pediatric patients, 2025. The diagnosis of ulcerative colitis was established in accordance with Clinical guidelines for ulcerative colitis for pediatric patients, 2025. Statistical processing was performed using parametric methods and exact formulas for percentages.

Results. 17/20 (85%) of our patients were diagnosed with Crohn's disease, inflammatory form, 3/20 patients (15%) – ulcerative colitis. The diagnosis of definite juvenile psoriatic arthritis, according to the Vancouver diagnostic criteria, was made in 11/20 patients (55%), probable – in 9/20 (45%). Boys predominated in the group – 14/20 (70%). The mean disease duration was 5.0 years (95% CI [3.21, 6.79] years). 13/20 (65%) patients had relatives 1 and 2 degrees of relatives suffered from psoriasis. All children with definite psoriatic arthritis (11/20 children) had plaque (vulgar) psoriasis. In 15/20 (75%) patients, the onset of articular syndrome was asymmetrical oligoarthritis. At the height of the disease, the oligoarticular variant was observed in 10/20 (50%) children, rheumatoid-like (polyarticular) in 3/20 (15%), spondyloarthritis with damage to peripheral joints in 7/20 (35%). The most commonly affected joints were the knee (15/20 (75%)), ankle (5/20 (25%)), and hip (8/20 (40%)) joints.

Conclusions. The articular syndrome in inflammatory bowel diseases associated with juvenile psoriatic arthritis is characterized by a frequent onset of the disease with joint damage (in 40%), asymmetric oligoarthritis at the onset and at the height of the disease, while isolated juvenile psoriatic arthritis is characterized by a pattern of development of the articular syndrome from oligo- to polyarthritis. The association of inflammatory bowel diseases and juvenile psoriatic arthritis is characterized by a high percentage of spondyloarthritis with damage to peripheral joints (35%). The most common joints involved are the knee and hip joints (75% and 40%), with a high incidence of enthesitis (55%), while in isolated juvenile psoriatic arthritis the knee and ankle joints are most often affected. The course of inflammatory bowel diseases against the background of psoriatic arthritis requires an individual approach to patient management and selection of therapy aimed at the common links in the pathogenesis of these conditions.

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